Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

CV events and HDL

The British Medical Journal has published the results of a systematic review and meta-analysis that aimed to investigate the association between treatment-induced change in high density lipoprotein (HDL) cholesterol and cardiovascular morbidity and mortality.

HDL levels are already recognised as an independent predictor of cardiovascular risk but it remains unclear whether medical intervention in addition to established treatments provides incremental benefit.

This study reviewed data from 108 randomised controlled trials including 299,310 participants. After the data were corrected for changes in low density lipoprotein (LDL) cholesterol measured differences in HDL were not associated with the risk of cardiovascular events, cardiovascular deaths or total deaths. When statistically modelling the data, a model using HDL and LDL variables was no better than a model using LDL alone.

The authors conclude that, "simply increasing the amount of circulating high density lipoprotein cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths".

An accompanying editorial notes that these findings are "relatively simple and consistent with clinical practice guidelines". However they also state that these results have some inherent limitations as they are based on mean HDL levels and therefore increasing HDL in selected patients with low HDL cholesterol may still be beneficial.

Action: Clinicians should continue to focus lipid modifying interventions to reduce cardiovascular risk on reducing LDL levels.

Thanks to Kevin Ashworth for spotting this article

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